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Sarcoptic/Demodectic Mange

The following question was received:
I spoke to one of your colleagues today and expressed my concerns with regard to my vet and conflicting information. I have 3 Shih tzu's that were being treated for Sarcoptic Mange with "Aludex Solution" 50ml in conjunction with "Stronghold, Spot on". I was also prescribed "Canaural". I first expressed my concerns to the vet in October/November as my dogs were scratching excessively and noticeable hair loss on my male Shih tzu, Whom had already been treated by another vet practice with Antibiotics and Steroids. I felt his condition was becoming worse day by day and decided to get a second opinion as i had done some research of my own on the Internet and come to my own conclusion that it was pointing to the above mentioned condition.
 My 3 Shih tzu's were booked in for scrapings, as a result of this i was told that 2 Shih tzu's had been scraped and a positive was confirmed on 1 of the 2 and therefore "Aludex Solution" was recommended along with 3 pipettes of "Stronghold, Spot on", though i was only given 50ml of Aludex for 3 dogs the vet said she would write up more if needed. Treatment for Ear Mites (Canaural) was also recommended on 2 of the Shih tzu's. It was also pointed out that 1 Shih tzu may need sedating for the removal of Ear Wax. I think this was overlooked and i pointed this out to the vet at a short while later explaining how difficult it was for myself to remove this Wax.
 I told my Vet that i had pugs and all small dogs had been in very close contact with one another, at a short time later all my pugs were examined and given the all clear accept for the treatment of "Canaural" and "Effipro Spot on" as Flea's were found on 2 adult pugs, though none of my other dogs had any signs of Flea's. I can only assume the Flea had been there for a Short length of time as i recall my daughter looking after 1 of my pugs for a Short while of whom has cats, However, "Effipro" Pipettes were prescribed. I later asked for "Stronghold" as a preventative measure for Sarcoptic Mange as well as Flea's.
 I also explained that i had mated 2 of the pugs and they were about 4/5 wks pregnant at the time of the consultation, and again expressed my concerns with regard to Sarcoptic Mange. All Shih tzu's began treatment and started to respond to treatment. Scratching had stopped and hair growth was noticed considerably on my Male Shih tzu. However, i have noticed that 2 of the 3 Shih tzu's have recently started to scratch and similar signs of Sarcoptic Mange are showing.
 I also have recently had 6 Pug puppies, vet checked by a different member of staff the same Vet Practice. She recommended having a Skin Scrape done on the pups as she felt signs of "Demodectic Mange" were present. I made an appointment for the following morning but was unable to keep the appointment and therefore cancelled. I was also concerned that given the fact all dogs had been in close contact with one another that i now have full blown Mange.
 I requested "Aludex + Stronghold" for the 3 Shih tzu's and was refused. I confronted the vet at 12.30ish today 2/02/2010 to begin for my Shih tzu's as i explained all the symptoms are starting to reappear at which point i was refused on the grounds that it is a prescription of medicine which is very strong and scrapings would need to be taken yet again. It was also pointed out to me for the first time that my Shih tzu's had proven a positive for Demodectic Mange as well as Sarcoptic. I was totally SHOCKED to learn this as it had never been pointed out before! I have no intentions of breeding from these Shih tzu's accept to rectify this problem before moving them on to pet homes. I also challenged the fact that given the difficulty in the scrapings for this Mite especially in its early stages if none were found it is still possible for the dogs to actually be positive.
What sort of Treatment would be recommended, the answer i was given was to be treated for other skin conditions and also continue week after week scrapings until a positive was found.
I hope you can understand my frustration with regard to this matter as i feel i am being given conflicting information and also being treated unfair. I am now reluctdent to have any scrapings done on my pug puppies as i also asked would it be kinder to have a scraping from mum rather than puppies as if mum were to prove positive then her pups are most likely to be treated for what ever results may occur.
I would also like to know if a copy of my Veterinary notes can be viewed by myself as there does seem to be some misunderstanding. Again only from my own research any dog in close contact with Sarcoptic Mange or Ear mite should be treated as it is a highly contagious condition and should not be bred from as it can be due to a low Immune System which is then passed on to pups.
I would also like to point out that a number of family members had contracted the Mange Mite (Sarcoptic) from my Shih tzu's this was also discussed with my Vet and my own GP.
Our vet's response:
This does seem to be a confusing picture and I am not sure what is going on with your dogs.

It is unusual, though not impossible, to have Demodectic and Sarcoptic mange at the same time. Maybe you have.

Demodectic mange is usually very easy to find on skin scrapes. If the dog has this problem, usually it is very easy to find on scrapes. Sarcoptic mange is very difficult to confirm on scrapes. Lots of dogs with Sarcoptic mange are diagnosed by response to treatment as much as anything else.

If Demodex is present, then it does not transfer to adult dogs easily (if at all) but puppies pick it up easily. Treatment is always prolonged (10 weeks or more of weekly baths). Sarcoptic mange is more easily treated. There is some resistance to Stronghold, but Advocate can be used as well.

I think you need to get a full understanding of exactly what your dogs have been diagnosed with, and how certain the diagnosis is. Then you can formulate a treatment plan and monitor the result.

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Sunday 20th January 2013